Failure to Prevent and Address Constipation in Two Residents
Penalty
Summary
The facility failed to implement adequate measures to prevent constipation for two residents who were reviewed for this issue. Both residents had complex medical histories, including diagnoses such as diabetes, end-stage renal disease, renal dialysis, cardiac arrest, seizures, and feeding tubes, and required assistance with all care. Documentation showed that both residents experienced multiple episodes of constipation, with extended periods of no bowel movements, sometimes lasting up to ten days. During these periods, there were also documented episodes of emesis, restlessness, combativeness, and resistance to care. For one resident, the care plan included monitoring for no bowel movement in three days and administering medications as ordered. However, records indicated that there were several instances where the resident went longer than three days without a bowel movement, and interventions were not consistently documented or implemented in a timely manner. The resident experienced repeated episodes of emesis and behavioral changes during these periods of constipation. Additionally, the resident had a fall during a time when constipation was present and had received interventions for bowel elimination. The second resident also had a care plan to observe for no bowel movement in three days and to administer medications as ordered. This resident experienced multiple episodes of constipation, with several periods of four or more consecutive days without a bowel movement. The resident received interventions such as Polyethylene glycol and Bisacodyl suppositories, but these were not always administered according to the facility's bowel protocol. The resident also experienced falls during periods of constipation. Interviews with nursing staff and the DON confirmed that the facility's bowel protocol was not always followed as intended, and that both residents had patterns of repeated constipation that were not adequately addressed.